DCMedical News: Wednesday, June 26, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, June 26, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Democratic Candidates Debate Tonight (and Tomorrow Night), 9-11 p.m. Eastern
A profile of the candidates and their challenges, (here, San Francisco Chronicle), each making their case in an estimated total of 5-10 minutes per person.
Senate and House Moving Closer on “Lower Health Costs Act” Features
The Senate Health, Education, Labor and Pensions (HELP) Committee will mark up the “Lower Health Costs Act” (here, bill summary here) today. House Republicans on the Energy and Commerce Committee released a statement (here) welcoming the Senate’s proposals on “surprise bills” and other elements of the HELP bill, as being close to their own.
CBO Releases New Baseline Projection of Spending, Taxation and Deficits
The Congressional Budget Office report (here) shows that federal debt held by the public will total 144 percent of gross domestic product (GDP) in 2049, an unprecedented level, compared to the current level of 78 percent of GDP, and also compared to the historic record of 106 percent set just after World War II. Also from the report, “Spending is growing faster than revenue--spending will grow rapidly, from less than 21 percent of GDP in 2019 to over 28 percent by 2049. Revenue will grow more slowly . . . As a result, annual deficits are expected to more than double from 4.2 percent of GDP in 2019 to 8.7 percent by 2049 . . . Major trust funds are headed toward insolvency. CBO projects the Highway, Pension Benefit Guaranty Corporation Multi-Employer, Medicare Hospital Insurance, Social Security Disability Insurance, and Social Security Old-Age and Survivors Insurance trust funds will all be exhausted in the next 13 years without action to stabilize their finances.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Private Equity, Again
“Paladin Healthcare” and “American Academic Health System” (AAHS) are on the verge of bankrupting Hahnemann University Hospital, according to The Philadelphia Inquirer. The Inquirer chronicled the growing financial distress of the Drexel University affiliate (here, April), the unsuccessful “turn around” by Paladin (here, May), and, most recently (here, Friday), a lawsuit by Drexel to compel Paladin/AAHS to keep the hospital in operation. “The lawsuit also criticizes the leadership of Joel Freedman, who controls AAHS through a trust, and demands $13 million allegedly owed for services Drexel's physicians provided at Hahnemann University Hospital.”
Inslee-Care, Continued
Politico (here) and the Commonwealth Fund focus on Washington state’s solution to care for an aging population. “It is old-fashioned social insurance, collecting funds from a broad population to pay for the future needs of those who need assistance. Workers will pay a mandatory payroll tax, but a small one: 58 cents per month for every $100 income starting in 2022. That works out to $18 a year for the average wage earner. These contributions will be banked in a trust fund. Although some benefits will be available to active employees and retirees starting in 2025, when fully implemented workers would be able to access their benefits (a lifetime maximum of $36,500 indexed to inflation) once they’ve paid into the program for 10 years and meet the medical system’s requirements for long-term care.” Beneficiaries decide how to spend their own account.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Extenders, Expanders and Modifiers—House Ways and Means Committee Bill Mark-Up Today
These bills will be acted on today: HR 3429, “A bill to provide for health equity and access for returning troops and servicemembers, to provide for ambulatory surgical payment transparency under the Medicare program, and for other purposes”; HR 3436, “A bill to amend title XVIII of the Social Security Act to remove cost-sharing responsibilities for chronic care management services under the Medicare program”; HR 3417, “A bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program”; HR 3414, “A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis”; HR 3439, “A bill to amend the Internal Revenue Code of 1986 and title XI of the Social Security Act to extend appropriations and transfers to the Patient-Centered Outcomes Research Trust Fund and to extend certain health insurance fees for such transfers, and for other purposes.”
DRUGS AND DEVICES
Pharmacy Benefit Manager (PBM) Problems in Ohio Began with Managed Medicaid
A study (here) last week in JAMA noted that PBM reforms in Ohio may “provide an important window into PBM practices nationwide and also may have implications for other state and federal reform efforts.” The problems appeared when Ohio changed from fee-for-service coverage for outpatient pharmacy purchases to “managed Medicaid” and the companies contracted to manage Medicaid, in turn, hired PBMs for the pharmaceutical benefits. Early assessment by an “independent study” showed savings to the state. However, “Ohio pharmacists increasingly expressed concerns that PBMs were engaging in anticompetitive behaviors and taking advantage of opaque proprietary pricing practices. For example, PBMs were providing preferential pricing to affiliated pharmacies over independent pharmacies. Some PBMs also used a controversial technique, ‘spread pricing,’ charging Ohio Medicaid high prices while paying pharmacies lower prices for the same drugs and pocketing the difference.” The result of Ohio’s audit: “In late summer 2018, Ohio Medicaid directed Ohio managed care plans to end their contracts with PBMs, effective January 2019. Plans were instead asked to adopt a transparent ‘pass-through’ pricing model whereby the managed care plan would pay the PBM the exact amount paid to the pharmacy for the prescription drug, a dispensing fee, and, in lieu of spread-based revenue, an administrative fee.” Also prohibited were gag clauses, contractual provisions attempting to limit information pharmacists can give to patients concerning prices. A table accompanying the article (here) shows the number and status (through March) of 233 bills in various state legislatures proposing to limit PBM activity.
READINGS AND REFERENCES
National Quality Forum Report
The report, submitted March 1, will be published in today’s Federal Register (here, NQF report begins on the 11th page). Secretary Azar’s message of introduction notes: “NQF reports that in 2018 it updated its measure portfolio by reviewing and endorsing or re-endorsing 38 measures and removing 40 measures . . . In addition to maintaining measures endorsement, NQF also worked to remove measures from the portfolio for a variety of reasons, such as, measures no longer meeting endorsement criteria; harmonization between similar measures; replacement of outdated measures with improved measures; and lack of continued need for measures where providers consistently perform at the highest level.”
Your HPSA List is Here
Health Professions Shortage Areas are listed by HRSA, with an introduction from the June 25 Federal Register here.
U.S. House of Representatives:
Members at https://www.house.gov/representatives.
Committees and Members at https://www.house.gov/committees.
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm.
Committees and Members at https://www.senate.gov/committees/membership_assignments.htm.
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June publication dates: 27
July publication dates: 9, 10, 11, 12, 15, 16, 17, 18, 23, 24, 25, 26
August publications dates: None
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.